Pages

Tuesday, 14 October 2014

Power words to avoid in healthcare

On words such as 'intelligence', 'insight' and 'discretion' used as tools in demonstrating power.........................

A colleague had an
email from a clinical director asking to ‘acknowledge that CT Cologram is a
scarce resource to be used intelligently’.

When we got talking
about this we wondered how one was supposed to respond, react or put this into
action. What did that mean? Does it mean that they as a department they were using
the resource like a bunch of idiots? Is this saying that they were a part of a
group of people with not such a high intelligence? They were talking about
doctors most of whom had at least two degrees and many years of training and
experience - generally thought of as abundant proof of intelligence.

You can see this
has raised my hackles. What is really interesting is this comes from a hospital
which had one of the highest utilisation of CT scans in the country. If they
were abusing CT facilities already, why would a cologram (colonography) be an
exception?

The issue is not
the CT use intelligent or otherwise. The issue is the lack of understanding of
how clinical management works and the use of operational management language.
It is the lack of analysis and lack of definition behind these statements that
are the problem. Of course no manager who imagines he/she is worth his/her salt
will ever agree that this type of communication is grossly deficient. In fact
the managers will insist that ‘intelligent use of resources’ is essential. And
they can prove it. They will prove it by letting others use the resource and
then using their higher hierarchical authority by making a post-event, ad hoc
individual judgement on others who used the resource intelligently. You can see
how it massages the ego of individual managers and riles up everyone else.

There are many
other terms which lack analysis or definition yet used very liberally by
everyone. Insight is one. Discretion is another.

Many doctors in
trouble are accused of lack of insight. A GMC related official described
insight as breathtaking arrogance in the face of overwhelming evidence.....
So, it is safe to assume that when evidence is presented to a doctor that
he/she is no good and yet the doctor maintains that he/she was good would
probably classed as lack of insight. At this point, it may look acceptable.

The point is, the
use of ‘lack of insight’ as a reason and sanctions that follow often comes from
a people with higher authority and directed against people with lower
authority. In medical practice there is none or very little evidence for many
things we do. In such a situation evidence becomes the view of a group of
people in power who are then not inclined to look at the evidence presented by
the weaker party. Insight becomes a power game.

Let us look at
discretion. Let us say that your boss in clinical medicine says that all patients
are not the same and you must use your discretion according to the given
situation. You are likely to think that your boss has given you a lot of
freedom. What you are actually being set up for is another power game where
your boss retains the right to question your discretion, pitch your discretion
with others discretion and to override your discretion. Now you might think
that is why you have bosses. But what actually happens is a clear recipe for
failure and conflict.

There are better
ways of dealing with these. At a simple level as a starting point is to stop
using such words which have the potential to confuse and cause harm; words such
as discretion, insight and intelligence in day to day operational activity. I
am not saying these words or their implications are not important, of course
they are; I am questioning if they should be used in day to day operational
management especially in healthcare.

Instead clear
definitions agreed as a group, in the form of specific and detailed protocols
with further second and third order protocols defined when the first one does
not fit might be a better way in operational management in healthcare. There
will be a situation when these definitions will not work in which case a
variation made after very quick group consultation which is then analysed later
may be needed.

The main issues are
that you will not like this since you might feel your autonomy is being
reduced; your boss won’t like it since he/she may feel that his/her power is
being reduced. Finally the chances are you, your colleagues and your boss will
not agree on most things at an operational level; well you see this is not your
fault as clinicians are taught only how to make individual decisions implemented
according to a power based hierarchical scale.

Clinicians have never been
taught on how agreements are reached and never experienced the power of
agreements between them.

There are clear
ways to achieve this. That is when you will find Success in Healthcare.

PS: If you would like to get away from the conventional
use of terms such as discretion, insight, intelligence and move to a different
approach; if you would like to know what agreement actually means and would
like help to achieve it – you are welcome to get in touch with me mr.hemadri at
gmail dot com

1 comment:

Does it not all arise from lack of respect of another's clinical ability and autonomy? When this is lacking, all tools lead to bullying and denigration - sometimes directly, sometimes indirectly, mostly without malice and occasionally with.